Open AccessMaternal near‐miss at university hospitals with cesarean overuse: an incident case‐control study
Author(s) -
Mohammadi Soheila,
Essén Birgitta,
Fallahian Masoumeh,
Taheripanah Robabeh,
Saleh Gargari Soraya,
Källestål Carina
Publication year - 2016
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/aogs.12881
Subject(s) - medicine , obstetrics , family medicine , medical emergency , emergency medicine
Cesarean section carries a substantial risk of maternal near‐miss morbidity. The aim of this study was to determine the frequency, causes, risk factors, and perinatal outcomes of maternal near‐miss at three university hospitals with a high rate of cesarean section in Tehran, Iran. Material and methods An incident case‐control study was conducted from March 2012 to May 2014. The modified WHO near‐miss criteria were used to identify cases. A control sample of 1024 women delivering at the study hospitals was recruited to represent the source population. Near‐miss ratio, crude and adjusted odds ratios with confidence intervals were assessed. Results Among 12 965 live births, 82 mothers developed near‐miss morbidities and 12 died. The maternal near‐miss ratio was 6.3/1000 live births. Severe postpartum hemorrhage (35%, 29/82), severe preeclampsia (32%, 26/82), and placenta previa/abnormally invasive placenta (10%, 8/82) were the most frequent causes of maternal near‐miss. Women with antepartum cesarean section (adjusted odds ratio 7.4, 95% confidence interval 3.7–15.1) and co‐morbidity (adjusted odds ratio 2.3, 95% confidence interval 1.4–3.8), uninsured Iranians (adjusted odds ratio 3.4, 95% confidence interval 1.7–7.1) and uninsured Afghans (adjusted odds ratio 4.7, 95% confidence interval 2.4–9.2) had increased risks of near‐miss morbidity. Stillbirth and extremely preterm birth were the most prominent adverse perinatal outcomes associated with maternal near‐miss. Conclusions Overutilization of cesarean section clearly influenced the causes of maternal near‐miss. A lack of health insurance had a measurable impact on near‐miss morbidity. Tailored interventions for reducing unnecessary cesarean section and unrestricted insurance cover for emergency obstetric care can potentially improve maternal and perinatal outcomes.